Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic.

Understanding the distribution of pathogens causing acute febrile illness (AFI) is important for clinical management of patients in resource-poor settings. We evaluated the proportion of AFI caused by specific pathogens among outpatients in Bangladesh. During May 2019-March 2020, physicians screened patients aged ≥2 years in outpatient departments of four tertiary level public hospitals. We randomly enrolled patients having measured fever (≥100.4°F) during assessment with onset within the past 14 days. Blood and urine samples were tested at icddr,b through rapid diagnostic tests, bacterial culture, and polymerase chain reaction (PCR). Acute and convalescent samples were sent to the Centers for Disease Control and Prevention (USA) for Rickettsia and Orientia (R/O) and Leptospira tests. Among 690 patients, 69 (10%) had enteric fever (Salmonella enterica serotype Typhi orSalmonella enterica serotype Paratyphi), 51 (7.4%) Escherichia coli, and 28 (4.1%) dengue detected. Of the 441 patients tested for R/O, 39 (8.8%) had rickettsioses. We found 7 (2%) Leptospira cases among the 403 AFI patients tested. Nine patients (1%) were hospitalized, and none died. The highest proportion of enteric fever (15%, 36/231) and rickettsioses (14%, 25/182) was in Rajshahi. Dhaka had the most dengue cases (68%, 19/28). R/O affected older children and young adults (IQR 8-23 years) and was detected more frequently in the 21-25 years age-group (17%, 12/70). R/O was more likely to be found in patients in Rajshahi region than in Sylhet (aOR 2.49, 95% CI 0.85-7.32) between July and December (aOR 2.01, 1.01-5.23), and who had a history of recent animal entry inside their house than not (aOR 2.0, 0.93-4.3). Gram-negative Enterobacteriaceae were the most common bacterial infections, and dengue was the most common viral infection among AFI patients in Bangladeshi hospitals, though there was geographic variability. These results can help guide empiric outpatient AFI management.

Molecular survey for tick-borne pathogens and associated risk factors in sheep and goats in Kano Metropolis, Nigeria.

Tick-borne pathogens (TBPs) pose an increased health and productivity risk to livestock in sub-Saharan Africa. Information regarding TBPs infecting small ruminants in Kano metropolis is scarce. Therefore, we investigated the molecular epidemiology of tick-borne pathogens of economic importance from sheep and goats in Kano, Nigeria using Polymerase chain reaction (PCR). A total of 346 blood DNA samples were collected from small ruminants and analyzed for TBPs using PCR and sequencing. Risk of infection was determined for age, sex, breed and animal species. Our results indicate the absence of piroplasmids (Babesia/Theileria) and Rickettsia spp. infections. The overall prevalence for Anaplasma spp. was 9.25% (32/346) with a higher prevalence in goats 13.59% (25/184) compared with sheep 4.32% (7/162). With respect to age of animals, goats >4 years had the highest prevalence of 32.45% (11/37) which differs significantly (P = 0.0059) compared with other age categories. Cross breed goats had a prevalence of 15.63% (5/32) compared with Kano brown breed 14.08 (20/142). Sex significant difference (P = 0.029) was observed in the goats with females having the highest prevalence 20.89% (14/67) compared with males 9.40% (11/117). Furthermore, with regards to sheep, no significant difference (P > 0.05) was observed with respect to age and breed. Finally, no significant difference (P > 0.05) was observed with the prevalence of Anaplasma spp. due to Body condition score (BCS) in both sheep and goats. Conclusively, the occurrence of TBPs in small ruminants is low. Continuous efforts in tick control must be sustained to ensure high productive yield and reduced disease burden associated with TBPs of sheep and goats in Kano metropolis.

Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses.

Cutaneous involvement can be an important sign of both COVID-19 and rickettsioses. Rickettsial infections may be first evident as an exanthem with eschars as a key finding. In contrast, eschars and necrotic lesions can be seen in critically ill COVID-19 patients. Both illnesses share a similar mechanism of infecting endothelial cells resulting in vasculopathy. Rickettsia parkeri and Rickettsia 364D are both characterized by eschars unlike Rickettsia rickettsii. Other eschar causing rickettsioses such as Rickettsia conorii, Rickettsia africae, and Orientia tsutsugamushi are commonly diagnosed in people from or having traveled through endemic areas. While there is no consensus on treatment for COVID-19, rickettsioses are treatable. Due to possibly serious consequences of delayed treatment, doxycycline should be administered given an eschar-presenting patient's travel history and sufficient suspicion of vector exposure. The proliferation of COVID-19 cases has rendered it critical to differentiate between the two, both of which may have overlapping vasculopathic cutaneous findings. We review these diseases, emphasizing the importance of cutaneous involvement, while also discussing possible therapeutic interventions.

Tick-borne rickettsioses in Brazil: what lessons can be learned from the COVID-19 pandemic.

In this commentary, the authors highlight the importance of basic research in the field of public health regarding the recent pandemic Covid-19, using tick-borne rickettsioses as an example. In addition, they alert politicians, government officials and managers of research funding agencies to increase the allocated financial resources to enhance basic research on public health in Brazil.